Background: In the current practice of periodontics, clinicians are faced with the challenge of not only addressing biological and functional problems present in the periodontium but also providing therapy that results in acceptable aesthetics. The presence of mucogingival problems and gingival recession around anterior, highly visible teeth exemplifies a situation in which a treatment modality that addresses both biological and aesthetic demands is required from the therapist. A variety of soft tissue augmentation procedures directed at root coverage have been documented in the literature utilizing autogenous or allogenic soft tissue grafting or guided tissue regeneration (GTR). The purpose of this review was to assess the effectiveness of newer materials in gingival augmentation procedures.

Background: Ideal placement of bone integrated implants to retain a prosthesis is critical for a successful final prosthetic restoration. Several sources have described the importance and use of surgical templates for the optimal placement of extraoral implants. The literature is replete with information explaining the use of surgic al templates for intraoral implant placement. Indeed, correct placement of implants facilitates creating a prosthesis that functions well and looks natural. To ensure proper implant placement, considerable effort should go into pre-surgical planning. It is clear that extraoral surgical templates aid in proper implant placement, yet the literature describing fabrication is limited. This article describes different methods for fabrication of surgical template for placement of implants for an auricular prosthesis.

Background: Lichen planus is a chronic inflammatory mucocutaneous disease. Mucosal lesions are classified into six clinical forms and there is malignant potential for Oral Lichen Planus (OLP); therefore, follow -up should be considered. There are many unestablished etiological factors for OLP. A genetic predisposition linked to Th, cytokine polymorphisms may promote the T cell-mediated immunological response to an induced antigenic change that is supposed to lead to OLP lesions. Some putative etiologic factors, mainly amalgam restorations and hepatitis C virus have been studied in detail. The diagnosis of OLP can be made from the clinical features if they are sufficiently characteristic, but biopsy is recommended to confirm the diagnosis, exclude dysplasia and malignancy and if active treatment is required. The aims of current OLP therapy are to eliminate mucosal erythema and ulceration, alleviate symptoms and reduce the risk of oral cancer. The management of OLP is mainly aimed at controlling the symptoms and topical immunomodulators such as powerful corticosteroids and calcineurin inhibitors have been used. However their long-term effects needs to be better explained and understood.

Background: The goal of modern dentistry is to restore the patient's dentition to normal contour, function, comfort, esthetics, speech, health and implant dentistry has the ability to achieve this goal. Although implant is considered to be a safe technique to replace tooth or teeth, certain complications are bound to occur with implants like any other surgical procedures. Implant surgery complications are frequent occurrences in dental practice and knowledge in the management of these cases is essential. The article highlights the complications in implant surgery, which helps to prevent them by proper patient selection, devising proper treatment plan and treating the implant cases in a way to avoid complications and failures associated with implants.

Relationship between Use of Aspirin and Post-Extraction bleeding Time: A Single Blind Study

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Kruti A Shah, Milind A Patel, Rohit Tatu, Vandana Patel

Background: The purpose of the study was to evaluate the effect of low dose aspirin before tooth extraction.
Materials and Method: The study group consisted of 5, patients who were scheduled to undergo dental extractions. All patients were receiving 7, - 15, milligrams of aspirin daily on a regular basis. The authors randomly divided the patients into two groups: those who stopped the aspirin therapy before the procedure and those who continued the aspirin therapy. One hour before the procedures, all patients underwent a bleeding time test.
Results: The mean (±Standard Deviation) bleeding time was 1.8±0.4, minutes for patients who stopped aspirin therapy one week before the procedure. For patients who continued aspirin therapy, the bleeding time was 3.1±0.6, minutes. However, both groups were within the normal bleeding time range and in both groups, a local hemostatic method was sufficient to control bleeding. No episodes of uncontrolled intra operative or postoperative bleeding were noted.
Conclusion: Low-dose aspirin therapy should not be stopped before oral surgery. Local haemostasis is sufficient to control bleeding.

Aim: Presence of Mast cells (MCs) near capillary sprouting sites suggests an association between MCs and anigogenesis. MCs are well recognized as being important in the generation of angiogenic response via the release of heparin and histamine and release and/or activation of extracellular matrix modified enzymes. Thus study was done to histologically evaluate and correlate the number of MCs and angiogenesis in different grades of Oral Squamous Cell Carcinoma (OSCC) and Verrucous Carcinoma (VC).
Materials and Methods : A retrospective study was conducted to elaborate upon the correlation between MCs and tumor angiogenesis. Microvessel density (MVD) was detected by immune-histochemical staining using anti CD3, monoclonal antibody and Mast cell density (MCD) was detected by toluidine blue staining.
Results: The results showed a significant correlation in the mean MVD and the mean MCD ( r= 0.75, p<0.001 ) in Well Differentiated OSCC. However, in the other grades of carcinoma and normal tissue there was no significant correlation between the mean MVD and MCD.
Conclusion: MC accumulation in tumors is probably a part of response to tumor derived chemoattractants. From our study and previous literature, there is an evidence that MCs in tumors are potentially angiogenic, but at the same time are pro-inflammatory and immunoamplifying in action.

Aim : In current era of dentistry attempts are being made to perform several dental procedures quickly and atraumatically as beyond efficacy there is a need for balance and comfort for patients. Measurement of gingival thickness (GTH) has become the matter of significant interest for periodontists, orthodontists and implantologists as well. However, there are relatively few studies investigating the GTH atraumatically and rapidly.The purpose of this study was to assess and compare the two methods of determination of GTH i.e. transgingival probing (TGP) and ultrasonographic method (USG) in association with site, age, gender, tooth wise and dental arch wise in Indian population.
Methods : Thirty systemically and periodontally healthy subjects were included in the present study. Gingival thickness was assessed in the maxillary and mandibular anterior teeth by both methods.
Results : It was observed that the younger age group had significantly thicker gingiva than older age group . The gingiva was found to be thinner in females than males and in the mandibular arch than the maxilla. Within the limits of the present study it was demonstrated that thickness of gingiva varies with the tooth sites, i.e. midbuccally and interdental papillary region and also with morphology of the crown.
Conclusions : In the present study, it was concluded that GTH varies according to site, age, gender tooth and dental arch wise. In comparison to TGP method, USG method assesses GTH more accurately, rapidl y and atraumatically.

Background: Placing implants in the posterior maxilla is challenging at times owing to poor quantity of bone and pneumatization of the maxillary sinus. In a patient desirous of implant related prosthesis, there arises a need to augment the bone height. The maxillary sinus lift technique using a lateral approach is frequently used for bone augmentation. This article reports one such treatment option for augmenting bone to place an implant.

Background: Fracture of anterior teeth is a common occurrence in young children and adolescents. Due to advancements in adhesive technology reattaching the patient's own fragment is gaining popularity. Tooth fragment reattachment not only takes care of original tooth anatomy but also the shade selection part. It is definitely a conservative approach which does not need tooth reduction to the extent of full coverage crowns and a cost effective treatment to a complicated problem. In this article a case is presented where post was used along with flowable resin to reattach the tooth.

Background: The concept of conditioning oral mucosa has gained momentum over the last few years. Different tissue conditioning materials and soft liners have been used for this purpose. But the limitations of these materials has led to the introduction of liquid-supported dentures, which is a newer alternative to conventional complete denture prosthesis in cases with inflamed tissues, atrophic and severely resorbed edentulous ridges. Liquid supported Denture consists of a base which is covered with a preshaped close fitting flexible foil containing a thin film of high viscosity liquid which cushions the underlying tissues. This case report describes fabrication of liquid-supported dentures for patients with compromised tissues.

Double Mesiodentes, Bilateral to Midline: A Report of Two Uncommon Cases

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Avina Banari

Background: Spontaneously erupted double mesiodentes, bilateral to midline are extremely rare and can alter both occlusion and appearance by affecting the eruption path, position, inclination and axial rotation of the maxillary permanent incisors.
Case Report: Two cases of uncommon occurrence of spontaneously erupted double mesiodentes, bilateral to midline are presented here. The first case report highlights a situation where in treatment has been sought due to esthetic concerns arising, following a spontaneous eruption of bilateral mesiodentes. The second case report highlights a situation wherein there has been disturbances related to increasing diastema, axial rotation and inclination of erupted permanent central incisors caused due to spontaneously erupted double mesiodentes with incidental radiographic finding of congenitally missing permanent maxillary lateral incisors. In both the cases, clinical and radiographic findings clinched the diagnosis and prompt extraction of the mesiodentes was undertaken to reduce the extent of possible future complications and orthodontic treatment.
Conclusion: Early diagnosis allows for minimization of the treatment required and prevents development of associated problems. Extraction of the mesiodentes in the early mixed dentition stage may facilitate good alignment of incisors, while minimizing orthodontic intervention for space loss, diastema and midline shift.

Background: Occlusal surface of the acrylic teeth of a single complete denture in opposition to natural dentition wears out with its use for a longer period of time, which may lead to decrease in the chewing efficiency, loss of vertical dimension of occlusion, change in centric occlusion, denture instability, temporomandibular joint disturbances etc. Re-fabrication of new denture set over a period of time, inclusion of highly cross linked acrylic teeth, amalgam or metal inserts on occlusal surface, use of composite, gold or metal occlusal surface, etc. are some of the treatment options available to counteract that problem. Several articles have described methods to construct gold and metal occlusal surfaces, some of which are time-consuming, expensive and require many cumbersome steps. This clinical case describes the sequence of steps for construction of metal occlusal surfaces on single complete denture using the lost wax technique.

Background: Mandibular second premolars with three canals (Type V, Vertucci) and separate foramina are very rare. The anatomy of the pulp chamber floor in these premolars usually reveals one lingual and two buccal orifices at the same level. This case report describes a second premolar with three canals and an unusual pulpal floor anatomy with one mesiobuccal and one distobuccal orifice at the same level and an orifice on the distolingual wall. Very careful examination of the pulpal space with an optical device and preoperative spiral computed tomography is recommended to locate any unusual orifices.

Accidental Ingestion of a Dental Bur Seen in a Paediatric Patient - A Case Report

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Rohan Bhatt, Applu Atrey, Ashish Kaur, Lipee Dave

Background: This article presents a case of accidental ingestion of dental bur by a patient during routine dental treatment. This article also points out the possible barrier techniques to prevent swallowing and ingestion of dental foreign objects by patient. An outline of the complications of swallowing/ingestion of foreign objects as well as the required diagnostic measures to be taken following the accidental swallowing and the different treatment options has been laid in brief.